Comparative Efficacy of Budesonide/Formoterol Versus Fluticasone/Salmeterol in Patients With Moderate-to-Severe Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Figures & data

Figure 1. Flow diagram illustrating the study selection process.

Table 1. Characteristics of the included studies in this meta-analysis.

Study	Country	Design	Diagnosis of COPD	Study period	Groups	n, M/F	Age, years	Patient selection
Altaf et al. [15]	India	PCS	GOLD	6 months	BF	30, 21/9	62.50 ± 9.69	NA
					FS	30, 22/8	60.50 ± 9.41
Blais et al. [11]	Canada	RCS	ICD-9	1 year	BF	1,131, 589/542	≥40	propensity matching
					FS	1,131, 589/542	≥40
Kalhan et al. [16]	USA	RCS	ICD-9	1 year	BF	1,441, 805/636	71.9 (9.9)	propensity matching
					FS	1,194, 641/553	72.1 (10.0)
Kern et al. [17]	USA	RCS	ICD-9	1 year	BF	3,697, 1,708/1,989	64.0 ± 11.8	NA
					FS	3,697, 1,765/1,932	63.7 ± 11.5
Larsson et al. [12]	Sweden	RCS	ICD-10	3.5 ± 2.4 year	BF	2,734, 1,288/1,446	67.6 ± 10.9	propensity matching
					FS	2,734, 1,278/1,456	67.6 ± 10.4
Muiser et al. [13]	Netherland	RCT	Clinical diagnosis	1 year	BF	103, 63/40	65 ± 7.83	propensity matching
					FS	92, 73/19	65 ± 6.98
Perrone et al. [18]	Italy	RCS	ICD-9	≥6 months	BF	4,680, 2,340/2,340	63.7 ± 13.0	NA
					FS	4,680, 2,340/2,340	63.7 ± 13.2
Roberts et al. [19]	USA	RCS	ICD-9	3-6 months	BF	3,385, 1,501/1,884	61.6 ± 11.23	propensity matching
					FS	3,385, 1,486/1,899	61.5 ± 11.51
Suissa et al. [20]	UK	RCS	ICD-10	1 year	BF	24,973, 13,680/11,293	70.7 ± 10.1	NA
					FS	61,251, 33,488/27,763	70.8 ± 10.2
Wang et al. [14]	China	RCS	ICD-9	1 year	BF	4,606, 3,602/1,004	71.86	NA
					FS	11,395, 8,786/2,609	71.79

BF: budesonide/formoterol; COPD: chronic obstructive pulmonary disease; F: female; FS: fluticasone/salmeterol; GOLD: The Global Initiative for Chronic Lung Disease; ICD: International Classification of Diseases; M: male; NA: not applicable; PCS: prospective cohort study; RCS: retrospective cohort study; RCT: randomized controlled trial.

Table 2. Outcomes of the sensitivity analysis and test of publication bias.

Outcomes	No. of studies	Sensitivity analysis		Egger’s test
		RRs or WMDs (95% CI)	Robust	p Value
Risk of COPD exacerbations	7	0.89 (0.80, 0.99)–0.96 (0.91, 1.01)	No	0.296
Risk of COPD hospitalizations	5	0.74 (0.64, 0.84)–0.80 (0.68, 0.95)	Yes	0.846
ED visits for COPD	3	0.78 (0.71, 0.87)–0.91 (0.64, 1.31)	No	0.988
Risk of pneumonia	5	0.72 (0.58, 0.90)–0.78 (0.57, 1.07)	No	0.831
Number of exacerbations	3	−0.14 (−0.39, 0.11)–0.04 (−0.19, 0.27)	Yes	0.948

CI: confidence interval; COPD: chronic obstructive pulmonary disease; ED: emergency department; RR: risk ratio; WMD: weighted mean difference.

Figure 2. Forest plots comparing exacerbations (A) and hospitalizations (B) between the budesonide/formoterol and fluticasone/salmeterol groups.

Figure 3. Forest plots comparing pneumonia (A) and emergency department visits for chronic obstructive pulmonary disease (B) between the budesonide/formoterol and fluticasone/salmeterol groups.

Figure 4. Forest plots comparing the length of hospitalization (A) and number of exacerbations (B) between the budesonide/formoterol and fluticasone/salmeterol groups.

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Data availability statement

The data analyzed in this study was available from the corresponding author upon reasonable request.